Submitted by Judith Gordon, Bernalillo
Presbyterian’s decision to drop Medicare Advantage plans in 2027 disrupts many seniors’ coverage—but creates an important opportunity.
Medicare Advantage plans attract seniors with low premiums and extra benefits such as dental and vision coverage. Yet those advantages can come at a cost. Because Medicare Advantage is private insurance, it shares all the drawbacks of other private insurance policies. Medicare Advantage has become so problematic that lawmakers of both parties now criticize the program for its prior authorization delays and denials, narrow provider networks, misleading marketing practices, and more.
A deeper problem is that once seniors enroll in Medicare Advantage, getting out can be difficult. Original Medicare was designed to cover only about 80% of medical costs, so most people need a supplemental Medigap policy. Seniors who choose Original Medicare when they first become eligible to enroll are guaranteed the right to buy a Medigap policy without an assessment of their health status (medical underwriting) and regardless of preexisting conditions. But those who try to switch later—typically, when they most need care—may face underwriting, leading to higher premiums or even denial of coverage.
Given these shortcomings, Medicare Advantage plans should come with a warning label: May be hazardous to seniors’ health.
However, many seniors cannot afford the premiums for Original Medicare and Medigap, forcing them to choose among Medicare Advantage options.
A better solution for seniors—and everyone else—is the elimination of private insurers that too often run roughshod over patients’ medical needs. A Medicare for All or single-payer system would provide universal healthcare coverage to all citizens while eliminating expensive administrative overhead. It would also allow the government to negotiate drug and service prices directly, potentially reducing overall healthcare costs and protecting individuals from medical bankruptcy.
When healthcare prioritizes health over profit, Americans thrive—our medical bills will finally shrink and our health will improve to match other advanced nations.